Frequently Asked Questions
Medicare Basics
- Part A - Hospital coverage
- Part B - Medical coverage
- Part C - Also known as “Medicare Advantage.” An “all in one” alternative to Original Medicare that includes Part A, Part B and usually Part D. In addition, plans may have:
- Lower out-of-pocket costs than Original Medicare
- Extra benefits that are not available through Original Medicare such as vision benefits, dental benefits, hearing benefits, or fitness or gym membership
- Part D - Prescription drug coverage. Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
Medicare Supplement plans are an alternative to Original Medicare or Medicare Advantage plans.
Medicare Supplement plans:
- Are designed to fill gaps left by Original Medicare.
- Generally cost more per month and may offer more comprehensive coverage than Medicare Advantage plans.
- Do not include prescription drug coverage. If you want that important option, you must purchase it separately.
- Allow you to see any provider who accepts Medicare.
- May not be combined with a Medicare Advantage plan.
You can sign up for Medicare Part A and/or Part B during your Initial Enrollment Period, the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
There are certain “enrollment periods” when you make changes to your Medicare coverage, these include:
- Medicare Advantage Open Enrollment Period from Jan 1. To March 31. During this time you can:
- Switch from one Medicare Advantage plan to another (with or without drug coverage)
- Drop your Medicare Advantage plan and return to Original Medicare. You’ll also be able to join a separate Medicare Prescription Drug Plan
- A Special Election Period when certain events happen in your life. For example:
- You move
- You are eligible for Medicaid
- You move to an institution, like a skilled nursing facility or long term care hospital
- You qualify for Extra Help with Medicare prescription drug costs
- You want to switch to a plan with a 5-star overall quality rating
If you qualify for an SEP, you may be able to join, switch, or drop a Medicare Advantage plan.
You may be able to receive help paying for your prescription drug costs through Medicare’s Extra Help program. This program helps people with limited income and resources pay for their Medicare prescription drug coverage, such as plan premiums, deductibles, copays or coinsurance.
Medicare Coverage
Once you enroll in Medicare, you’ll have three basic choices for receiving your health coverage:
- Original Medicare (Part A and Part B)
- Medicare Advantage (Part C)
- Medicare Supplement
Original Medicare covers doctor visits and hospital stays. You usually pay a monthly Part B premium, must meet your yearly deductibles, and then pay 20% for the cost of your care. There is no limit to your out-of-pocket costs each year.
It’s important to understand that Original Medicare doesn’t cover everything and doesn’t include Medicare Part D prescription drug coverage.
No, prescription drug coverage is not included with Original Medicare or Medicare Supplement Plans.
Medicare Part D prescription drug coverage is an important coverage option that is available either as a standalone Prescription Drug plan Plan (PDP) or as part of a Medicare Advantage Plan.
Remember, if you do not sign up for prescription drug coverage during your Initial Enrollment Period you may encounter a Late Enrollment Penalty if you sign up at a later date.
To get Medicare Part D Prescription Drug Coverage, you’ll need to enroll in either a Medicare Advantage plan with prescription drug coverage (MA-PD plan) or a standalone Medicare Prescription Drug Plan (PDP).
Prescription drug coverage is not included with Original Medicare or Medicare Supplement plans so it’s important to understand your options.
A Formulary, also called a drug list, is a list of prescription drugs covered by your Medicare Advantage plan.
Plan Enrollment
Enrolling in one of our plans is easy! Visit our How to Enroll page for more details.
Membership
You can authorize a representative (such as a relative, friend, advocate, attorney, or a doctor) to act on your behalf. To appoint a representative, complete the Appointment of Representative form and follow the instructions on where to send it.
Visit our Appeals and Grievances web page for more information about this form and how to authorize a representative.
Your Medicare Advantage plan will renew automatically each year unless you make changes to your coverage. You may choose to change your coverage during the Annual Enrollment Period from: October 15 – December 7 each year.
If you are a member of a Dual Eligible Special Needs Plan (DSNP), your renewal is contingent upon your Medicaid eligibility.
If you qualify for a Special Enrollment Period, you can change plans according to the situation that is allowing you a Special Enrollment Period.
Welcome to Wellcare By Allwell! We look forward to starting a new journey with you. As a new member you will receive materials from us, such as:
- A new Membership ID Card
- A Welcome Kit
- A Welcome telephone call from our Member Services team
Creating an account is easy! Go to the Member Login and select “Create New Account.” Follow the prompts to create your account.
If you have questions setting up or logging into your account, please contact Member Services. We are here to help!
For certain kinds of drugs, you can use our mail-order services. Generally, the drugs provided through mail-order are drugs that you take on a regular basis for a chronic or long-term medical condition such as high blood pressure or diabetes. The drugs available through our plan’s mail-order service are marked as “mail-order or MO” in our List of Drugs (Formulary). Learn more about Mail Order Service.
You can ask questions and get support from our Member Services team. We’re here to help. Contact Us.
How to Get Care
Network providers are doctors, pharmacies, hospitals, and other health care professionals or facilities that have an agreement with us to deliver covered services to members in our plan. You can use our Find a Provider tool to see if your doctor, pharmacy, or other healthcare professional or facility is in our network.
Your doctor or pharmacy should be an in-network provider, so your health services are covered. If you use an out-of-network provider, you will likely pay more for your healthcare services.
If you need care and an in-network provider is unable to provide this care, you may be able to get care from an out-of-network provider.
Please note out-of-network/non- contracted providers are under no obligation to treat Wellcare By Allwell members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services
Your primary care provider is the doctor or other provider you see first for most health problems. He or she makes sure you get the care you need to keep you healthy. He or she also may talk with other doctors and health care providers about your care and refer you to them. In some Medicare health plans, you must see your primary care provider before you see any other health care provider.
If you don't have a PCP, here are ways to choose one:
- Use our Find a Provider tool to find an in-network provider and contact Member Services with your selection.
- Or, you can call us! Member Services will help you find a PCP.
If you already have a PCP:
That’s great! You may want to contact Member Services or use our Find a Provider tool to make sure your PCP is in our network. If your PCP is not in our network, don’t worry, we will work with you to make sure you are assigned a PCP that is in our network.
Deciding where to go for care can sometimes be confusing. For non-emergency illness or injury, call your Primary Care Physician (PCP), contact the 24/7 Nurse Advice Line or visit an in-network urgent care facility. If you feel you are experiencing a life-threatening condition, go to the emergency room (ER).
The following information may help you decide where to go for the type of care you need.
DO YOU HAVE A PHYSICAL INJURY OR ILLNESS LIKE THE FLU? IF YES:
- Call Our 24/7 Nurse Connect at:
1-833-542-0693 (TTY: 711)
Get quick, reliable answers to your health questions.
- Call Your Primary Care Provider (PCP)
Set up an appointment to see your doctor.
- Go to In-Network Urgent Care
Get quickly diagnosed and treated for less serious illnesses or injuries.
CALL 9-1-1 IMMEDIATELY OR GO TO AN EMERGENCY ROOM IF:
You feel you have a life-threatening injury or illness like:
- Chest pains
- Bleeding that won’t stop
- Shortness of breath
- Broken bones
- Poisoning
- Severe cuts or burns
Always follow up with your PCP if you have gone to an emergency room, visited an urgent care facility or had a hospital stay.
If you have questions please, contact Member Services.